HIV Testing of Pregnant Women

Routine human immunodeficiency virus (HIV) prenatal testing is the current recommendation from the American College of Obstetricians and Gynecologists (ACOG) and from the Institute of Medicine (IOM). The IOM outlined new recommendations in 1998 and ACOG released similar guidelines in 2000 and renewed them in 2008.

Background

In 1994, federal guidelines for prenatal HIV testing were developed because of new therapy that reduced the chance for women infected with HIV to pass it to their children.

The guidelines at that time recommended that health care providers give detailed pre-test counseling to all pregnant women, explaining the risks of AIDS and the benefits of being tested.

While prenatal HIV testing and treatment seemed to increase after the 1994 guidelines were released, many health care providers were only suggesting HIV prenatal testing to those women considered high risk for HIV infection. Therefore, many women were still not being tested or treated and the number of children born with HIV was still unacceptably high, according to the 1998 IOM report.

The prediction is that by offering HIV testing routinely to ALL pregnant women, more women would be identified and treated for HIV, and this would decrease the number of children born with HIV.

Current Status of HIV Testing

The Center for Disease Control and Prevention, ACOG, and the IOM all recommend universal HIV testing with patient notification as a routine component of prenatal care. If a patient declines testing, this should be noted in the medical record. Some state laws require testing for all pregnant women, while others do not.

Pregnant Women with HIV

Prevention of transmission of HIV from mother to fetus (vertical transmission) is a major goal in the care of pregnant women with HIV. Earlier studies have shown that treatment of the mother with Zidovudine (AZT) during pregnancy and labor and of the newborn could reduce the transmission rate from 25% to 8%. More recent studies suggest the risk can be reduced to less than 2%.

For a woman whose infection is well-controlled with medications, the risk approaches zero. Those with high circulating levels of HIV may be offered a cesarean section before they go into labor, as this reduces the chance the baby will be infected. HIV positive women should not breastfeed.